Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.
Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom.
Rev Recent Clin Trials. 2021;16(1):75-80. doi: 10.2174/1574887115666200406115150.
Haemorrhoidal Disease (HD) is a frequent anal disorder and one of the most common findings identified at the colorectal clinic. This article aims to provide an overview of the anatomy, physiology and pathophysiology of haemorrhoids and haemorrhoidal disease.
Internal haemorrhoids are vascular cushions located in the anal canal, above the dentate line and covered by columnar epithelium. They contribute to the faecal continence and the sensitivity of the anal canal. The enlargement and/or sliding of haemorrhoidal tissue produce symptoms and complications, the so-called haemorrhoidal disease.
A systematic research was realized, looking at the best evidence in literature, searching PubMed, Embase, Cochrane library and the most renowed textbooks of colorectal surgery from January 1980 to January 2020.
Aetiology and pathophysiology of HD are still controversial, but multifactorial. Disruption of stromal scaffolding, enlargement of vascular component, elevated anal pressure and rectal redundancy represent key events in the development and complications of the disease. Local inflammation may also play a role. Goligher's classification remains the most widely used. Thorough patient history and examination are paramount to diagnose HD, excluding other anal or colonic pathologies.
Several aspects of etiopathogenesis and pathophysiology remain controversial. Further studies are needed to obtain a better understanding of the disease.
痔病（HD）是一种常见的肛门疾病，也是肛肠门诊最常见的发现之一。本文旨在概述痔和痔病的解剖学、生理学和病理生理学。
内痔是位于齿状线以上、柱状上皮覆盖的肛门内血管垫。它们有助于维持粪便的控制和肛门的敏感性。痔组织的增大和/或滑动会产生症状和并发症，即所谓的痔病。
对 1980 年 1 月至 2020 年 1 月期间的文献进行了系统研究，检索了 PubMed、Embase、Cochrane 图书馆和最著名的结直肠外科教科书，以寻找最佳证据。
痔病的病因和病理生理学仍存在争议，但多因素。基质支架的破坏、血管成分的增大、肛压升高和直肠冗余是疾病发展和并发症的关键事件。局部炎症也可能起作用。Goligher 分类仍然是最广泛使用的分类。详细的病史和检查对于诊断 HD 至关重要，需要排除其他肛门或结肠疾病。
病因和病理生理学的几个方面仍存在争议。需要进一步的研究来更好地了解这种疾病。
